Strokeis one of the most common neurological disorders in clinical practice.

It isthe leading cause of adult disability. According to WHO, it is the secondcommon cause of death worldwide.18,22WHOdefined stroke as “Rapidly developed clinical signs of focal disturbance ofcerebral function, lasting more than 24 hours or leading to death, with noapparent cause other than vascular origin”.10,21, 37Strokehas major impact on mortality, morbidity and economic burden.39 Approximately15 million stroke events occur worldwide each year, two-thirds of these eventsoccur in people living in low-income and mid­dle-income countries.12 Surveys in differentparts of India have shown that the prevalence of stroke varies in differentregions of India and ranges from 40 to 270 per 1,00,000 population.

18Thedifferent forms of stroke have different specific causes.ISCHEMIC STROKEIschemicstroke is the most common form of stroke, accounting for about 85% of strokes.This type of stroke is caused mainly through blockages or narrowing of thearteries that provide blood to the brain, resulting in ischemia. These blockages are often caused dueto blood clots which can be caused by fatty deposits within the arteries calledplaque.26HEMORRHAGIC STROKEHemorrhagicstroke is caused by the arteries in the brain either leaking blood or burstingopen. The leaked blood puts pressure on brain cells and damages them. Theseruptures can be caused due to conditions such as hypertension,trauma, blood-thinning medications and aneurysms.

Intracerebral hemorrhage iscommon than subarachnoid hemorrhage.26TRANSIENT ISCHEMIC ATTACK (TIA)TIAsare different from the before mentioned kinds of stroke because the flow ofblood to the brain is briefly interrupted. TIAs are similar to ischemic strokesbecause they are often caused by blood clots.

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26 TIAs should be regarded as medical emergencies justlike the other kinds of stroke, even if the blockage of the artery is temporarybecause they confer an important  shortterm risk of stroke.4Approximately 15% of ischemic strokes are preceded by a TIA.38Alves et al.,defined disability as a dynamic process that encompasses physical, mental and emotionalconditions.15 Thedegree of disability and reduced functional capacity after stroke is etiologicallymultifactorial.8 Theserisk factors can be broadly divided into modifiable and non-modifiable riskfactors.

Non modifiable risk factors include age, sex, race/ethnicity, and familyhistory. Major modifiable risk factors include hypertension, cardiac disease,diabetes, dyslipidemia, cigarette smoking, alcohol drinking and sedentary lifestyle.20, 27, 31Forischemic stroke, most frequently associated risk factors are age, hypertension(HTN), dyslipidemia, diabetes mellitus(DM), smoking, asymptomatic carotidstenosis and various cardiac disorders. HTN and oral anticoagulation therapyare the factors most frequently associated to intracerebral hemorrhage whileHTN, smoking and alcohol consumption have been reported as risk factors tosubarachnoid hemorrhage.

27, 35Functionaloutcomes, which are measured by means of disability and an individual’s loss ofindependence in activities of daily living, are considered to be among the mostmeaningful patient outcomes.11, 15In this study modified rankin scale (mRS) is used as a measure to assessthe functional outcome in neurologic patients. It is a clinician reportedmeasure of global disability and has been widely applied for evaluating strokepatient outcomes, degree of disability or dependence in daily activities .3, 9Itis an ordinal scale with broadly defined scores from 0 (no residual symp­tomsfrom stroke) to 5 (bedridden) and 6 for death.2 It was designed to assess post-stroke recovery levelsand has also been used to evaluate pre-stroke disability levels.29modified Rankin scale 9, 17,36 Score mRS 0 No symptoms at all 1 No significant disability despite symptoms; able to carry out all usual duties and activities 2 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance. 3 Moderate disability; requiring some help; but able to walk without assistance 4 Moderately severe disability; unable to walk without assistance and unable to attend own bodily needs without assistance 5 Severe disability; bedridden, incontinent and requiring constant nursing care and attention 6 Death*        *Used commonly in clinical trials                 Clinicaltrial use of the mRS is global and often used by research nurses andprofessions allied to medicine.

14, 40Thus global nature of mRS thereby allows the clinician to consider non-physicalattributes essential to a person’s self-maintenance and well-being, such ascognition and language, social functioning and post stroke mood disturbances,particularly depression, that may contribute to perceived disability.9Inthis study we used mRS-9Q questionnaire to assess the patient functionaloutcome and analyze the possible factors influencing the outcome. It is in thepublic domain and a free web calculator available at www.

modifiedrankin.comThe present aim of the study isto assess the functional disability in cerebral stroke patients and evaluatedifference in patient improvement before and after medical therapy according toage, gender, type of stroke, severity and co-morbid conditions by using the mRSscores.Strokeis one of the most common neurological disorders in clinical practice. It isthe leading cause of adult disability. According to WHO, it is the secondcommon cause of death worldwide.18,22WHOdefined stroke as “Rapidly developed clinical signs of focal disturbance ofcerebral function, lasting more than 24 hours or leading to death, with noapparent cause other than vascular origin”.

10,21, 37Strokehas major impact on mortality, morbidity and economic burden.39 Approximately15 million stroke events occur worldwide each year, two-thirds of these eventsoccur in people living in low-income and mid­dle-income countries.12 Surveys in differentparts of India have shown that the prevalence of stroke varies in differentregions of India and ranges from 40 to 270 per 1,00,000 population.18Thedifferent forms of stroke have different specific causes.ISCHEMIC STROKEIschemicstroke is the most common form of stroke, accounting for about 85% of strokes.

This type of stroke is caused mainly through blockages or narrowing of thearteries that provide blood to the brain, resulting in ischemia. These blockages are often caused dueto blood clots which can be caused by fatty deposits within the arteries calledplaque.26HEMORRHAGIC STROKEHemorrhagicstroke is caused by the arteries in the brain either leaking blood or burstingopen. The leaked blood puts pressure on brain cells and damages them. Theseruptures can be caused due to conditions such as hypertension,trauma, blood-thinning medications and aneurysms. Intracerebral hemorrhage iscommon than subarachnoid hemorrhage.26TRANSIENT ISCHEMIC ATTACK (TIA)TIAsare different from the before mentioned kinds of stroke because the flow ofblood to the brain is briefly interrupted.

TIAs are similar to ischemic strokesbecause they are often caused by blood clots.26 TIAs should be regarded as medical emergencies justlike the other kinds of stroke, even if the blockage of the artery is temporarybecause they confer an important  shortterm risk of stroke.4Approximately 15% of ischemic strokes are preceded by a TIA.38Alves et al.,defined disability as a dynamic process that encompasses physical, mental and emotionalconditions.15 Thedegree of disability and reduced functional capacity after stroke is etiologicallymultifactorial.

8 Theserisk factors can be broadly divided into modifiable and non-modifiable riskfactors. Non modifiable risk factors include age, sex, race/ethnicity, and familyhistory. Major modifiable risk factors include hypertension, cardiac disease,diabetes, dyslipidemia, cigarette smoking, alcohol drinking and sedentary lifestyle.20, 27, 31Forischemic stroke, most frequently associated risk factors are age, hypertension(HTN), dyslipidemia, diabetes mellitus(DM), smoking, asymptomatic carotidstenosis and various cardiac disorders.

HTN and oral anticoagulation therapyare the factors most frequently associated to intracerebral hemorrhage whileHTN, smoking and alcohol consumption have been reported as risk factors tosubarachnoid hemorrhage.27, 35Functionaloutcomes, which are measured by means of disability and an individual’s loss ofindependence in activities of daily living, are considered to be among the mostmeaningful patient outcomes.11, 15In this study modified rankin scale (mRS) is used as a measure to assessthe functional outcome in neurologic patients. It is a clinician reportedmeasure of global disability and has been widely applied for evaluating strokepatient outcomes, degree of disability or dependence in daily activities .3, 9Itis an ordinal scale with broadly defined scores from 0 (no residual symp­tomsfrom stroke) to 5 (bedridden) and 6 for death.

2 It was designed to assess post-stroke recovery levelsand has also been used to evaluate pre-stroke disability levels.29modified Rankin scale 9, 17,36 Score mRS 0 No symptoms at all 1 No significant disability despite symptoms; able to carry out all usual duties and activities 2 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance. 3 Moderate disability; requiring some help; but able to walk without assistance 4 Moderately severe disability; unable to walk without assistance and unable to attend own bodily needs without assistance 5 Severe disability; bedridden, incontinent and requiring constant nursing care and attention 6 Death*        *Used commonly in clinical trials                 Clinicaltrial use of the mRS is global and often used by research nurses andprofessions allied to medicine.14, 40Thus global nature of mRS thereby allows the clinician to consider non-physicalattributes essential to a person’s self-maintenance and well-being, such ascognition and language, social functioning and post stroke mood disturbances,particularly depression, that may contribute to perceived disability.9Inthis study we used mRS-9Q questionnaire to assess the patient functionaloutcome and analyze the possible factors influencing the outcome. It is in thepublic domain and a free web calculator available at www.modifiedrankin.comThe present aim of the study isto assess the functional disability in cerebral stroke patients and evaluatedifference in patient improvement before and after medical therapy according toage, gender, type of stroke, severity and co-morbid conditions by using the mRSscores.